Wedgwood Gardens Care Center

In the surveyor’s words

From the most serious findings on record at Wedgwood Gardens Care Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF760Mar 3, 2023

  Based on observation, interview, record review, and review of pertinent facility documentation, it was determined the facility failed to: a.) protect residents from the potential for significant medication errors by not following the standards of practice for the administration of medication, and b.) implement the facility policy for Medication Administration when 1 of 3 nurses (Licensed Practical Nurse) on 1 of 3 units (Garden) observed during a medication pass observation prepared and attempted to give high-risk medications to the wrong resident. […]

• Immediate jeopardy, isolatedF600Nov 9, 2022

  COMPLAINT#: NJ159023 Based on interviews, medical record review, and other pertinent facility documentation on [DATE], [DATE], and [DATE], it was determined that the facility failed to provide services to prevent Neglect of a resident (Resident #2). Resident #2 had a Physician's Order and a Plan of Care for a Full Code and a known diagnosis of Unspecified Chronic Obstructive Pulmonary Disease, Pulmonary Embolism without Acute Cor Pulmonale, and Shortness of Breath. On [DATE] at approximately 4:30 a.m., on the ,d+[DATE] shift, the Registered Nurse (RN) found Resident #2 unresponsive without a pulse and respirations in bed. […]

• Immediate jeopardy, isolatedF678Nov 9, 2022

  C#: NJ159023 Based on observation, interviews, medical record review, and review of other pertinent facility documentation on [DATE], [DATE], and [DATE], it was determined that the facility failed to activate the Emergency Response System (ERS), which included: calling for other staff to assist, calling 911, getting the crash cart and (emergency supplies), getting the Automatic External Defibrillator (AED) and continuing Cardiopulmonary Resuscitation (CPR) (an emergency procedure that can help save a person's life if their breathing or heart stops) until the Emergency Medical Technicians (EMTs) arrived for a resident (Resident #2). […]

• No harm, potential for more than minimal, widespreadF880Mar 19, 2025

  Based on interview, record review, and review of Centers for Disease Control and Prevention (CDC) and American Society of Heating, Refrigerating and Air-Conditioning (ASHRAE) recommendations, the facility failed to implement their water management program to reduce the potential for exposure to opportunistic waterborne pathogens including Legionnaire's disease (a serious pneumonia infection). This had the potential to affect 92 of 92 residents who resided at the facility. Findings Include: Review of the CDC document titled Legionella . Prevention and Control, dated 03/25/21 and located at https://www.cdc.gov/legionella/index.html, indicated . The key to preventing Legionnaires' disease is to reduce the risk of Legionella growth and spread. […]

• No harm, potential for more than minimal, widespreadF880Mar 3, 2023

  Based on observation, interview, and review of pertinent facility documentation, it was determined that the facility failed to a.) follow appropriate infection control practices for proper hand hygiene during meal observation in 1 of 1 resident dining rooms (Main Dining Room), b.) ensure staff wore appropriate proper personal protective equipment (PPE) for a resident on transmission-based precautions (TBP) (Resident #57), and c.) provide proper hand hygiene and proper infection control practices for 1 of 3 nurses observed during medication adminsitration. This deficient practice was identified on 1 of 3 nursing units (Garden). This was cited at a level F as the deficient practice was cited at the last standard survey of 01/20/21. The deficient practice was evidenced by the following: 1. […]